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V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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I'm assuming that your ex has custody of your son. He is primary parent and lives with your son in another state, correct? What probably has happened is that almost every time that dad has to deal with anything medical for the kid, there is a issue. He is not the policy holder, he does not have access to the account or any standing to do so as it is insurance provided by you. And you are not there to deal with any conflicts or confusion on coverage and do any co-pay. So dad has to deal with co-pay or total reluctance of providers to accept & process a claim. Or providers want a substantial deposit as it's not his insurance - and providers have to always be concerned that an insurer won't pay or issues with coverage when parents are divorced.
If dad is now low income and qualifying for Medicaid; then children in his household I bet automatically get enrolled in Medicaid or CHIP. For dad, this may be a good way to make health care simpler for all. If a parent is eligible for Medicaid, then having the kids also covered makes sense for the program as it makes managing care more co-ordinated. Kinda like how if you are on SSDI you also qualify for Medicaid.
If he told you about it, it doesn't sound like he is being sneaky. Now when your insurance finds out that Medicaid or CHIP is now available to pay, they are probably going to shift all or most of responsibility of payments to Medicaid or CHIP. There could be some blowback on this with the providers. Like say your son was seeing an dermatologist who takes your insurance which pays a higher reimbursement rate. But once he is on Medicaid & if there is a cross-over period of payments, your insurance could do a claw-back of payments as Medicaid can now pay. The providers are in a tough spot when this happens as they will bill the policy holder - which is you - for the difference or if they do not take Medicaid, then bill you for the whole private pay with no priority discount that the insurer negotiates. The clawback period can be for several months. With bills taking months or even a year + to run through the bill / rebill / clawback / rebill cycle. I had to deal with this with my mom once she became eligible for Medicaid in 2011. I got a bill this August from a pharmacy provider who got the clawback and it's 3 years ago! So both of you need to be aware of this.
From the Medicaid.gov website: The Children's Health Insurance Program (CHIP) provides health coverage to eight million children in families with incomes too high to qualify for Medicaid, but can't afford private coverage. Signed into law in 1997, CHIP provides federal matching funds to states to provide this coverage.
It seems that the son has private coverage through his mother and therefore doesn't qualify.
The father, however, may qualify for the Basic Health Program due to inadequate income - 133% to 200% of the Federal Poverty Level. This is spelled out on the Medicaid website as part of the Affordable Care Act (Obamacare) and is an option in each state. He may be confusing this with Medicaid. To qualify for BHP, he would have to be less than 65 years old, ineligible for Medicaid, and unable to afford insurance on the open market or through his employer.
It's all so confusing, but this could be a legal issue if he is fraudulently obtaining CHIP. After all, it's a government agency. Hope you get this settled...
Dual insurance is not unusual. Since they are on Medicaid now, you probably are required to notify your insurance company of the change. Leave it at that.
His father told me today that he and my son have medicaid now. He said that they were going to sign him up for the CHIP program but that he qualified for medicaid. Neither of them have any disability. I called the WV medicaid office but they had me on hold for a substantial amount of time. I will try again in the morning. I understand that you can use both, but don't understand how he qualifies when I am paying for everything? It seems to me that he may not have told them about having insurance at all.
Your son and his father would not both be receiving Medicaid unless they BOTH were eligible medically. If one has an expensive chronic illness only that one would be eligible. I wonder if his father is not insured through his work and he simply signed up for healthcare insurance through his state plans, and also covered his son. Not "Medicaid" but some other insurance plan. Why do you think it is Medicaid?
My children were covered by both my health insurance and their father's for several years. One insurance pays first and the other one covers any deductible, etc. This is perfectly legal.
I am thinking that it has to be fraud. I don't understand needing medicaid when you have full coverage insurance. I will check the website out. Thanks.
Obamacare changed everything effective January 1, 2014, for example, eligibility was expanded to 133% of the federal poverty level. Jeannegibbs is correct in saying that Medicaid/CHIP is separate from private insurance. Medicare and I would also presume Medicaid varies from state to state. If you have concerns, I would go to the Medicaid website and see if that gives you some illumination.
It doesn't sound right to me, either. Are you sure this is Medicaid? How would your son be medically eligible for Medicaid? There must be more to this story. Are you thinking that the application was fraudulent?
My son is not disabled. His father works. The insurance is really good and covers everything with a small copay of like 20 dollar doctor visits. It doesn't seem right to me.
People can have insurance and be on Medicaid. I take it that your son has some kind of disability? With many chronic conditions the costs of treatment and especially care exceed what insurance covers. The insurance is still used, but Medicaid pays for needs over and above that.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
If dad is now low income and qualifying for Medicaid; then children in his household I bet automatically get enrolled in Medicaid or CHIP. For dad, this may be a good way to make health care simpler for all. If a parent is eligible for Medicaid, then having the kids also covered makes sense for the program as it makes managing care more co-ordinated. Kinda like how if you are on SSDI you also qualify for Medicaid.
If he told you about it, it doesn't sound like he is being sneaky. Now when your insurance finds out that Medicaid or CHIP is now available to pay, they are probably going to shift all or most of responsibility of payments to Medicaid or CHIP. There could be some blowback on this with the providers. Like say your son was seeing an dermatologist who takes your insurance which pays a higher reimbursement rate. But once he is on Medicaid & if there is a cross-over period of payments, your insurance could do a claw-back of payments as Medicaid can now pay. The providers are in a tough spot when this happens as they will bill the policy holder - which is you - for the difference or if they do not take Medicaid, then bill you for the whole private pay with no priority discount that the insurer negotiates. The clawback period can be for several months. With bills taking months or even a year + to run through the bill / rebill / clawback / rebill cycle. I had to deal with this with my mom once she became eligible for Medicaid in 2011. I got a bill this August from a pharmacy provider who got the clawback and it's 3 years ago! So both of you need to be aware of this.
It seems that the son has private coverage through his mother and therefore doesn't qualify.
The father, however, may qualify for the Basic Health Program due to inadequate income - 133% to 200% of the Federal Poverty Level. This is spelled out on the Medicaid website as part of the Affordable Care Act (Obamacare) and is an option in each state. He may be confusing this with Medicaid. To qualify for BHP, he would have to be less than 65 years old, ineligible for Medicaid, and unable to afford insurance on the open market or through his employer.
It's all so confusing, but this could be a legal issue if he is fraudulently obtaining CHIP. After all, it's a government agency. Hope you get this settled...
My children were covered by both my health insurance and their father's for several years. One insurance pays first and the other one covers any deductible, etc. This is perfectly legal.
I'd be curious to hear what you find out.